Access Application
Government Information (Public Access) Act 2009
INFORMATION YOU NEED TO KNOW BEFORE MAKING AN ACCESS APPLICATION
THE INFORMATION YOU ARE SEEKING MAY ALREADY BE AVAILABLE TO YOU
Details concerning decisions made by NSW Police Force(NSWPF) in response to an application made pursuant to the
Government Information (Public Access) Act 2009 (GIPA Act), that may be of interest to other members of the public, may
be included on a Disclosure Log. The NSW Police Force's Disclosure Log provides details of:
The date the application was decided;
A description of the information to which access was provided;
A statement as to whether the information is now available to other members of the public and
How the information can be accessed.
Consultation will occur with an applicant prior to information being placed in the Disclosure Log.
Click
here to access NSW Police Force (NSWPF) disclosure logs or visit:
https://www.police.nsw.gov.au/online_services/requesting_information/disclosure_logs
DO YOU NEED INFORMATION RELEVANT TO AN INSURANCE CLAIM?
If you are seeking a copy of a motor vehicle collision or crime incident report (event only) that you have reported for
insurance purposes, this information can be obtained through the NSWPF Insurance Services Unit. Click
here or visit:
https://www.police.nsw.gov.au/online_services/insurance_services_unit_‐_application_for_incident_reporting
UNDER GIPAA LEGISLATION, THERE ARE OCCASIONS WHERE INFORMATION MAY NOT BE MADE
AVAILABLE TO AN APPLICANT – SUCH INSTANCES ARE DETAILED BELOW
There is a public interest consideration against disclosure of information if disclosure of the information could reasonably
be expected to have one or more of the following effects:
(a) reveal an individual’s personal information,
(b) contravene an information protection principle under the
Privacy and Personal Information Protection Act 1998 or
a Health Privacy Principle under the
Health Records and Information Privacy Act 2002,
(c) prejudice any court proceedings by revealing matter prepared for the purposes of or in relation to current or future
proceedings,
(d) prejudice the fair trial of any person, the impartial adjudication of any case or a person’s right to procedural
fairness,
(e) reveal false or unsubstantiated allegations about a person that are defamatory,
(f) expose a person to a risk of harm or of serious harassment or serious intimidation,
(g) in the case of the disclosure of personal information about a child—the disclosure of information that it would not
be in the best interests of the child to have disclosed,
(h) prejudice the prevention, detection or investigation of a contravention or possible contravention of the law or
prejudice the enforcement of the law.
CORONIAL MATTERS
If the information you require relates to a deceased person/s whose death was investigated by the State Coroner,
please contact the Coroner's Office before completing this application, on telephone no. (02) 8584 7777, or visit the
State Coroner www.coroners.justice.nsw.gov.au (as information in relation to Coronial matters can only be released
by the Coroner’s office).
NSWPF Access Application Form
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Date of Effect: 1 April 2018
Access Application
Government Information (Public Access) Act 2009
INSTRUCTIONS FOR COMPLETING YOUR APPLICATION
Please complete this form to apply for access to information held by the NSWPF pursuant to the
GIPA Act. Please
mark the relevant boxes with a tick.
If you require your personal information, you
MUST provide a copy of your Proof of Identity
If you are making this application on behalf of another person, you
MUST ensure that person completes the
‘Authorisation’ section of this form or attach a separate authorisation
1. APPLICANT DETAILS
Title
Family Name
Given Name/s
Previous Names/Aliases (If applicable)
Date of Birth (if your own application)
Company Name (If applicable)
Company ABN
Company Reference
(If Applicable)
(If Applicable)
Residential Address (Unit/street name/suburb)
State
Postcode
Postal Address if different to residential address or As above
State
Postcode
Contact No.
Email Address
2. AUTHORISATION TO OBTAIN INFORMATION ABOUT THE PERSON THE INFORMATION
RELATES TO
NSWPF Access Application Form
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Date of Effect: 1 April 2018
Access Application
Government Information (Public Access) Act 2009
TO BE COMPLETED BY THE PERSON THE INFORMATION RELATES TO – OR ATTACHED SEPARATELY
I authorise the NSW Police Force to release information about me in matters relating to this access application, to the
Person/Legal Representative/ Company/Agency named in Section 1
Your Full Name
Date of
Birth
Address
Signature
Date
3. INFORMATION REQUESTED
What information are you requesting?
Criminal History only
My criminal history
Criminal history of other
Please provide the name(s) and date(s) of birth of the
person(s)
person(s) in the Information Description box on page 4
Event report(s) only
Where you are requesting information for multiple
events, please supply information for each event
separately in the Information Description box on page 4
Event number:
Where/who incident reported to
(Officer name/Police Area
Command/Police Assistance
Line/other) (if known)
Date of incident (if known)
Involved party/parties (if known):
Event report(s) and related
Please provide the event number(s) and specific
information
information you are seeking, in the Information
Description box on page 4
Describe the information you would like to access in the box below, in enough detail to enable reasonable searches to
be conducted – e.g. car registration number, date of Birth, location etc.
Please supply any additional information that you feel will support your application (attach additional pages if
necessary).
If your application is unclear as to the information you require, or you do not provide sufficient information, your
application may be deemed invalid.
Please note that pursuant to section 75 of the GIPA Act, the NSWPF
is not required to create a new document to
respond to your application
NSWPF Access Application Form
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Date of Effect: 1 April 2018
Access Application
Government Information (Public Access) Act 2009
INFORMATION DESCRIPTION
4. PROOF OF IDENTITY
If seeking access to
personal information, you
MUST provide copy of one of the following documents to
confirm the identity of the involved party
Australian Drivers
Current Australian Passport
Other proof of identity
Licence
(e.g. Government issued identity or proof of
age card)
Please note, information may not be able to be released if identification requirements are not fulfilled
5. APPLICATION FEE
(Please note that an Access Application cannot be deemed valid without receipt of the application fee of $30)
I attach the following payment of the $30.00 application fee (Do NOT send cash)
Cheque
Money Order
Credit Card
Cheques and Money Orders should be made payable to the
NSW Police Force
Completed Credit Card Payment
Form
MUST be attached
6. PROCESSING CHARGES
A processing charge of $30.00 per hour may be applied pursuant to Section 64 of the GIPA Act. You will be notified prior, if
processing charges apply. Some applicants may be entitled to a 50% reduction in their processing charges. Further
information about this will be advised at the time of notification of additional processing charges.
PRO
7. CONSULTATION
The GIPA Act requires an agency to consult with third parties when considering the potential release of other person(s)
information (pursuant to Section 54 of the GIPA Act).
Where consultation with a third party is required, the time to respond to your application will be extended by
10 working days.
Where information requested is considered ‘non‐personal’ additional charges will apply – you will be notified should
this apply to your application.
Where another person’s details are contained within the information you are requesting, do
you wish for those persons to be contacted to obtain their consent to release their
Yes
No
information to you? (If you do not consent to our agency consulting with involved persons,
their information may not be released to you).
NSWPF Access Application Form
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Date of Effect: 1 April 2018
Access Application
Government Information (Public Access) Act 2009
When consulting, do you agree for this agency to provide your details as the ‘applicant’ to
the other party and/or a third party? (If you do not consent to our agency providing these
Yes
No
details, this may impact on the consulted agency’s/third party’s decision to release
I agree
I do not agree
information).
8. FORM OF ACCESS
Where information is located and able to be released, how do you wish to access this information?
A copy of the document(s)
Inspect the document(s)
Access in any other way (please specify)
9. PRIVACY STATEMENT
The NSWPF is subject to the
Privacy and Personal Information Protection Act 1998 and the
Health Records and Information
Privacy Act 2002 which require this agency to comply with Information and Health Privacy Principles.
Your personal information is being collected to process your application for information. The NSWPF may use your
personal information for the purposes of processing your application within the agency.
The NSWPF is required to collect personal information directly from the individual unless the individual has authorised
collection of the information from someone else. The NSWPF will not disclose your personal information without your
consent unless authorised by law.
Your personal information will be held by NSWPF at 1 Charles Street, Parramatta NSW 2150. You have the right to access
and correct the information if you believe that it is incorrect.
10. APPLICANT’S SIGNATURE
Applicant’s Signature
Date
11. APPLICATION LODGEMENT OPTIONS
Via Post
Via Email
NSW Police Force
External Information Access Unit
xxxxxxx@xxxxxx.xxx.xxx.xx
Locked Bag 5102
Parramatta NSW 2124
A credit card authority must accompany any emailed application
Tel: (02) 8835 6888
Applicant Checklist
Completed all pages of the application form
Provided proof of identity – personal applications
Enclosed payment
Completed Authorisation Section (where applicable)
NSWPF Access Application Form
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Date of Effect: 1 April 2018